肝病患者血清铁代谢指标与肝损伤关系的探讨

目的探讨肝病患者铁代谢相关血清学指标的临床诊断意义及铁在肝损伤过程中的作用。方法检测67例肝病患者血清铁调素、血清铁和铁蛋白水平,分析其与丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(ALB)等肝功能指标的相关性。依据肝病病因将患者分为HBV感染组、HCV感染组、酒精性肝病组,依据肝病病变程度分为肝炎组、肝硬化组。分析不同分组情况下,各组患者血清铁代谢指标与肝损伤的关系并比较组间差异性。结果 67例患者中,血清铁与ALT、AST均呈正相关(r=0.4788,P0.0001;r=0.4457,P0.0001)。血清铁蛋白与ALT、AST均呈正相关(r=0.3330,P=0.0022;r=0.4437,P0.0001)。铁调素与ALB呈正相关(r=0.4467,P=0.0195)。酒精性肝病组血清铁蛋白(1230.0μg/L)明显高于HBV感染组(388.5μg/L)和HCV感染组(211.0μg/L),P均0.05;HBV感染组明显高于HCV感染组,P0.05。HBV感染组血清铁明显高于酒精性肝病组(19.4μmol/Lvs.9.5μmol/L,P=0.0427)。肝硬化组铁调素与血清铁呈负相关(r=-0.7070,P=0.0001)。肝硬化组血清铁显著低于肝炎组(15.3μmol/Lvs.22.5μmol/L,P=0.0136)。结论肝病患者铁调素、血清铁、血清铁蛋白水平与ALT、AST、ALB等肝功能常用检测指标具有相关性。铁负荷增加可加重肝病患者肝细胞的损伤,铁代谢水平对判断肝病病情变化、开展干预治疗具有指导意义。

The relationship between the indicators of iron metabolism and hepatic injury in patients with liver diseases

Objective To investigate the clinical and diagnostic significance of the indicators related with iron metabolism (hepcidin, serum ferritin) and the role of serum iron in hepatic injury. Methods Hepcidin, serum iron, serum ferritin, AST, ALT, ALB were detected and analyzed in 67 patients of liver disease. The relationship between the indicators of ironic metabolism and liver injury was analyzed according to groups with different etiology (HBV group, HCV group, alcoholic liver diseases group) and pathological degree (cirrhosis group and hepatitis group). Results Serum iron levels were positively correlated with ALT(r = 0.4788, P < 0.0001) and AST(r = 0.4457, P < 0.0001). Serum ferritin levels were positively correlated with ALT(r = 0.3330, P = 0.0022) and AST(r = 0.4437, P < 0.0001). Hepcidin was positively correlated with ALB(r = 0.4467, P = 0.0195). Serum ferritin in patients with alcoholic liver disease was higher than that in HBV group(1230.0 μg/L vs. 388.5 μg/L, P < 0.05)and HCV group(1230.0 μg/L vs. 211.0 μg/L, P < 0.05)respectively. Serum ferritin in HBV group was higher than that in HCV group(P < 0.05). Serum iron in HBV group was higher than that in patients with alcoholic liver disease(19.4 μmol/L vs. 9.5 μmol/L, P = 0.0427). Hepcidin in patients with cirrhosis was negatively correlated with serum iron (r = -0.7070, P = 0.0001). Serum iron in patients with cirrhosis was lower than that in patients with hepatitis(15.3 μmol/L vs. 22.5 μmol/L, P = 0.0136). Conclusions It has significant correlation between hepcidin, serum iron,serum ferritin and ALT, AST, ALB in patients with liver diseases. The overload of iron may enhance the hepatic injury. Detection of indicators of iron metabolism is useful in diagnosis and treatment in liver diseases.